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Azzolino v. Dingfelder.
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Azzolino v. Dingfelder.
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Opinion of the Attorney General No. 88-046.
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A comparative analysis of the right to die in the Netherlands and the United States after Cruzan: reassessing the right of self-determination.
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Monitoring patient rights--a clinical seminar.
Israel enacted the Patient Rights Law in 1996. The Law embodies a movement from paternalism to autonomy in doctor-patient relations. The following year, law students at the Israeli Centre for Academic Studies participated in a clinical seminar designed to measure internalisation ofthe Law, through personal interviews with hospitalized patients. The seminar can be adapted for medical students. The methodology is taken from human rights field work. The objective is to use patient rights as indicators of quality of care in medical settings. Students studied the text and principles of the Law in light of personal testimonies taken from relatives and friends. They developed an open-structured questionnaire, and were trained in interviewing with due respect for the patients' dignity and privacy, and the need to obtain their free and informed consent to the interview. The interviews were conducted in Hadassah Hospital, Jerusalem, after receiving approval of the Helsinki Committee. The findings, though in no way statistically valid, are nonetheless interesting. Students received training in listening and advocacy skills. The approach is conciliatory rather than adversarial. The thesis is that respect for patient rights is an efficient tool for quality control, risk management, conflict resolution and prevention of litigation.
Work stressors and cardiovascular disease.
Over the past 20 years, an extensive body of research evidence has documented that psychosocial work stressors are risk factors for hypertension and cardiovascular disease. These stressors, which appear to be increasing in prevalence, include job strain (the combination of psychological job demands and low job control), imbalance between job efforts and rewards, threat-avoidant vigilant work, and long work hours. This article reviews the evidence linking these stressors with hypertension and CVD, and the physiological and social psychological mechanisms underlying the associations. Also described are methods for measuring work stressors and new, more accurate techniques for measuring blood pressure. Finally, strategies for reducing work stressors and preventing hypertension and CVD are reviewed. These include clinical assessment, worksite health promotion, work organization interventions, legal approaches and work site surveillance.
The right not to know and coronary angiography: is the common law of Australia consistent with patients' wishes?
In "The Right Not to Know: Patient Autonomy or Medical Paternalism?" (2000) 7 JLM 286 Judy Gutman qualitatively examined the direction of the law relating to the duty of medical practitioners to disclose information to their patients about risks associated with medical treatment. Prompted by theoretical issues raised in that article, a quantitative study was performed. The study focused on the wishes of patients referred for coronary angiography regarding information about the risks inherent in that procedure. The results of the study contribute to the ongoing academic discussion about risk disclosure and consent to medical treatment and demonstrate a need for further empirical research in the area. The study also highlights the desirability of clinical medical practice conforming to the tenets of the common law and vice versa.
Observations on the first year of Oregon's Death with Dignity Act.
Using data from the files of Compassion in Dying, we describe 34 individuals who approached Compassion wanting to use the Death with Dignity Act and who died during the first year of the Act's implementation. Of these 34, 10 died using medication prescribed under the Act. Using first-hand data from the dying individuals, their families, and their health care teams, we provide comparisons between predicted outcomes and actual experiences, discuss important elements of the physician-patient relationship, and describe several averted suicides and homicides. We also review changes in end-of-life care in Oregon and provide recommendations about issues in need of further research.
Complying with the Privacy Act. A survey of medical records management.
BACKGROUND: A survey of 142 South Australian general practices was conducted on the eve of the new Privacy Act amendments coming into force. OBJECTIVE: The survey had two aims: to establish the extent to which medical records systems were already compliant, and to identify those areas in which change would be required in order to achieve compliance with the requirements of the new legislation. DISCUSSION: The sample was biased in favour of larger group practices. Among the practices surveyed, the areas of best compliance were in providing security, allowing patients access to records and obtaining consent for disclosure of information. There was poor compliance with the requirement to provide patients with information about medical records, or to have a practice policy on privacy. Anonymous care was rarely offered to patients. General practices will need to develop policies and procedures to address these requirements of the new law. Some general practices met the standard required by the amended Privacy Act before it came into force. For those who were not compliant, relatively simple measures will overcome the most common deficiencies.
Non-voluntary and involuntary euthanasia in The Netherlands: Dutch perspectives.
During the summer of 1999, twenty-eight interviews with some of the leading authorities on euthanasia policy were conducted in the Netherlands. They were asked about cases of non-voluntary (when patients are incompetent) and involuntary euthanasia (when patients are competent and made no request to die). This study reports the main findings, showing that most respondents are quite complacent with regard to breaches of the guideline that require the patient's consent as a prerequisite to performance of euthanasia.
Consent: a Cartesian ideal? Human neural transplantation in Parkinson's disease.
The grafting of human embryonic cells in Parkinson's disease is an innovative and hopefully useful therapeutic approach. However, it still concerns a very small number of patients and is only suggested as a research protocol. We present here a study of the problems of information and consent to research within the framework of this disease in which the efficacy of medical treatment is shortlived. The only French center to use this treatment (Hôpital H. Mondor in Créteil) has received authorization from the Comité Consultatif National d'Ethique (Consultative National Committee on Ethics). Eleven patients were treated between 1991 and 1998. The study of the results of a questionnaire sent to those patients showed the difficulties met in evaluating the perception of information despite intact intellectual capacities in people "prepared to risk everything." In France, the duty to inform patients during research procedures is regulated by the Huriet Act. However, it is not easy to guarantee genuine consent when preliminary information is given to patients psychologically impaired by the slow and ineluctable course of their disease. In these borderline cases, a valid consent seems to be a myth in terms of pure autonomy when considered with the Cartesian aim of elimination of uncertainty. The relevance of this concept of genuine consent probably makes more sense as aiming at a Cartesian ideal which is perhaps more in the spirit rather than in the letter. It is in that same spirit that, from the outset, we propose to define t he practical ways of answering the patients' request for information, even sometimes after consent has been given.
Laws and practices relating to euthanasia and assisted suicide in 34 countries of the council of Europe and the USA.
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Minority children in pediatric research.
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Disclosure of tardive dyskinesia: effect of written policy on risk disclosure.
Over half of the states in the country have written statutory and/or regulatory policies that require psychiatrists treating inpatients within the state mental health system to disclose risks associated with treatment to voluntarily admitted patients. A severe side effect associated with the long-term use of neuroleptic medication is tardive dyskinesia (TD). A nationwide study was conducted to investigate the effect of written risk disclosure policy on psychiatrists' self-reported disclosure of the risks associated with neuroleptics to individuals diagnosed as having schizophrenia of a chronic nature. Participating in the study were 520 psychiatrists from 94 state/county mental hospitals located in 35 states. Fifty-four percent of those psychiatrists reported that they typically disclosed TD to the target patient population. The study results did not support the hypothesis that the presence of statutory and regulatory policy on disclosure of risk results in psychiatrists typically disclosing TD to patients.
Cruzan and the demands of due process.
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Involuntary hospitalizations of patients with mental disorders in Vrapce Psychiatric Hospital: five years of implementation of the first Croatian law on protection of persons with mental disorders.
AIM: To analyze data on the practice of involuntary hospitalizations of patients with mental disorders in Vrapce Psychiatric Hospital from January 1, 1998, when the Law on Protection of Persons with Mental Disorders came into power, to December 31, 2002; with particular reference to the changes and supplements to the Law on December 1999. METHOD: The data on patient's sex, age, and diagnosis were collected from the medical records. Patients were diagnosed according to ICD-10 criteria. When a patient had two or more diagnoses, he or she was placed in category of the primary diagnosis. Results were statistically analyzed by descriptive statistics and chi-square test. Statistical significance was set to p<0.01. RESULTS: The rate of involuntarily hospitalized patients increased by significantly from 1998 to 1999 (from 30.8% to 39.6%; p<0.01, chi square test). This rate decreased to 5.6% in 2000 (p<0.01), and continued to decrease in 2002 (3.5%). There was no difference between involuntarily hospitalized patients regarding sex in 1998 (p=0.302) and 1999 (p=0.136). Men were significantly more often involuntarily hospitalized than women in 2000, 2001, and 2002 (p<0.01). Schizophrenia and other psychotic disorders were the most common diagnoses among involuntarily hospitalized patients in each of the observed years. CONCLUSION: Changes and supplements to the Law on Protection of Persons with Mental Disorders from December 1999, which abolished the necessity for a written consent for hospitalization and the necessity for prescribed procedure of hospitalized persons who were mentally incompetent to consent for hospitalization, led to significant decrease in the number of involuntary hospitalizations.